Advancing Compassion in Health Care

SAN FRANCISCO, CA - It was some 20 years ago that Bridget Duffy's life as a doctor was changed by one patient's experience in an intensive care unit.

It was late at night and Duffy was sitting on the foot of the man's bed, watching as a stream of specialists and other care providers paraded through his room, picked up his medical chart and "dealt with the machines that dealt with the defective body parts," but never spoke to or touched the patient.

"It was then that the light bulb went on," says Duffy, a physician and the chief medical officer for Vocera Communications, Inc, a h ealth care communications firm based in San Jose, Calif. "The patient wasn't defective and fragmented, but the system was."

The experience and a chance encounter with magazine article prompted Duffy to make a cold call to Earl Bakken, inventor of the pacemaker and founder of Medtronic. Bakken was getting some attention for his work helping to build a better patient experience at North Hawaii Community Hospital.

Since then the pair have worked together to restore compassion and dignity as a central focus of health care systems.

Making the changes don't have to be big, Duffy says, they can be small things that have big impacts, like redesigning the hospital gown to provide the patient with more coverage, or simply asking a patient to talk about the hopes and fears they may have about a pending medical procedure.

"Not 'Who is your insurance? Do you have a living will? And here's your co-pay,'" Duffy said in November at the Science of Compassion Conference in San Francisco. Underwritten in part by Dignity Health, the event was part of a weeklong series of gatherings, seminars and workshops all focused on scientific and academic study which explores the relationship between compassion and well-being.

The daughter of a physician and surgeon, Duffy understood the lesson of compassion in health care as a child, watching her father get up from the dinner table each night and call each of his patients who had had surgery that day.

"He told me, 'Bridget, you shouldn't have to be someone or know someone to get a humane experience, you have to treat every human being this way,'" she recalls.

That's the kind of benchmark for patient care Dignity Health is setting, the company's President and CEO Lloyd Dean said at a conference session later in the week.

Dignity is working on multiple levels _ from its administrative offices to employee staffing and bedside care _ to weave the values of compassion and kindness into everything they do. Their hospitals and care sites nationwide reflect the ministerial goals of the original Sisters of Mercy nuns who arrived in San Francisco in 1854 during an outbreak of cholera and typhoid fever to care for the sick.

The Dignity Health experience should mean two things, Dean said: Patients will get the best possible clinical care and they will be treated like human beings.

"What we are trying to do at Dignity Health is standardize human compassion so that regardless of where you enter a care site within our system, you can expect that you will treated in a certain kind of way," Dean said. "You are not just going to be a number. You are going to be a person and you will feel that you are an integral part of the care team."

But the reality of modern health care doesn't make that easy. Health systems are often focused on stripping out waste and have often squeezed out the human values most of us believe should be central to health care, leaving in its wake exhausted, burned out care providers who rush to deliver medical service.

Boston Children's Hospital pediatrician Elizabeth Rider says she typically only has 10 minutes for each visit with an infant patient, nearly half of which gets gobbled up by her medical assistant who changes the child's diaper and gathers the initial vital statistics.

"There's no time to get to know your patients very much and the capacity for compassion is strained," says Rider. "Medical residents in the 1980s spent 20 percent of their time with patients. In 2012, it was 12 percent with patients and half their time with a computer screen."

Rider believes fostering relational competency in health care providers and institutions is central to fixing the health care system. Caregivers need to work to former deeper relationships with patients and move beyond the checklist of questions about ailments and challenges. But that doesn't just mean turning off pagers and looking people in the eye, Rider says, it's about being present.

"The goal is a sort of way of being, a presence rather than just tasks and skills. You have to have tasks and skills but the relationship is essential," says Rider, who is also director of academic programs at the Institute for Professionalism and Ethical Practice at the hospital and Harvard Medical School.

One way Rider is working to spread that message is through her work as director of the International Charter for Human Values in Healthcare, a collaborative of people, organizations and institutions worldwide working to restore human values to the practice of medicine and care delivery.

The charter has five values, which were identified through surveys of patients around the globe and include: Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare.

Riders' goal is to engage individual care providers and institutions around the globe to the charter's values. Such commitments promise to transform education and research practices to include the development of relationship and communications skills competencies and to create health care experience for patients and caregivers in the future that is grounded in compassion and ethical behaviors.

Medicine is, after all, a moral and altruistic enterprise, Rider says.

"If the patient is dying ... the family isn't going to remember what the morphine drip was or the respirator settings. The family is going to remember the words that you say. That can be very harming, or very healing and helpful," she said. "We need to choose to act altruistically by supporting the patient and family perspectives and by thinking about the underlying ethical meaning of our work."